**Warning: brain dump ahead! After writing this I realize that it might be a little depressing to read, but I just need to get all of this out of my head so that I can hopefully stop thinking about it for a minute.
I spent the ENTIRE day arguing over insurance plans and drug coverage. Over the past couple of weeks I have been transferred to countless representatives, explained my story over and over and over again, and been shut down at every turn. I hate to say it, but I think that Aetna will finally defeat us. We are not going to give up on the issue, we still have an appeal floating around out there, and a contact to the CF legal team to see if we have any options… but it just isn’t looking good.
We finally understand why they changed the plan in the first place, they entirely did away with the plan Jesse was on. We never should have believed Aetna when the told us not to worry about it and that everything would stay the same. It doesn’t seem legal that they can do this with no warning and without sending documentation on the coverage of the new plan. At this point we can’t say for sure what is covered and what isn’t. I don’t understand why we weren’t given opportunity to choose which new plan we get. Now that it was taken this long to get to this point we’re pretty much stuck. If we change plans we aren’t sure if the pre-existing condition clause will kick in since he’s only been on this last plan for six weeks… that would leave us worse off.
We’ve had offers from several of our CF friends to donate some of their old or unused medication to us. We so appreciate the offers, but we can’t expect that to be a long-term solution. I guess we’ll just have to see how Jesse does without those two medications. Maybe the combination of his new Speriva and all the exercise we’ve been doing will make up for the loss of the two inhaled medications, but that seems doubtful. At least it will cut down on long treatment times.
We finally found some documentation online showing the category that Jesse’s aerosol medications fall under. Conveniently, they’ve decided that ALL Cystic Fibrosis agents are now a tier 4… meaning the co-pay is 20% of the cost of the drug, thousands per month. This doesn’t leave many options. He’s left with albuterol (I even take that for asthma symptoms) and hypersal (salt water to promote coughing). They’ve taken away everything that actually treats CF!
It’s just makes me so mad that Aetna can decide, just like that, to exclude such critical medications that Jesse has been on for years. The combination of all the drugs he is now on has kept him off if IV’s for over two years now… a long-time record for him! Our last angle with the one person we contacted with any logical sense will be to reason with her that it will cost them more to fight the infections with IVs when he gets sick than it will to provide the preventative drugs in the first place.
We took my new ring to the jewelry store this afternoon to be re-sized. Part of me felt like returning it to use that money for a more necessary expense… like buying the meds we need. Then Jesse reminded me of the amount we spent… it wouldn’t hardly make a dent in the cost of these meds.
The most frustrating part is that every time we gain some real traction with our foster care licensing… we run into a crisis almost immediately afterwards. It’s been one road block after another. When we were taking our certification class, business all but completely dried up for a couple of months. We seriously considered whether we should give up the business to go back to work. After months of stable business, we went full steam to getting licensed as quickly as possible. Now that we getting really close we get hit with this. Jesse went back to considering needing to get a job for better health insurance. That would mean I would need a job too because he would be making less, which would mean not being able to do foster care. That cannot be the answer!
Maybe the situation will seem less sad after the shock wears off. We’ve always had such an easy time getting all of our medical costs taken care of. I just hate to think that his lungs will suffer because of Aetna’s decision. I hate feeling so helpless to do anything useful to help the situation.
